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HomeMy WebLinkAbout0050 PRINCE HINCKLEY ROAD - Health 50 PRINCE HINCKLEY RD, CENTERVIL A= 172 174 - TOWN OF BARNSTABLE LOCATIONS � ��, � �G� - SEWAGE # VILLAGE r ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS I BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of le ching facility) , Feet Furnished by ` ��;6G�/ O . LO'C N S E W A G PE RMIT NO- OLZ. VILLAGE INSTA LLER'S NAME & ADDRESS .� ��� A-►�{+ �`pry �-��.. B U 1'L D E R OR OWNER O&A&er-Vt 11.E DATE . PERMIT ISSUED DATE COMPLIANCE ISSUED .�� �� r t(.� ex� r W , ,\ Y'� 1 i o� r ,.6eb FRx -No...... -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD..;O�E 7/ G�i� � - OF....... ............................. v rz ----_ Appliration -for 43W.Vatia1 Works Towitrurtion Vrruift Application is hereby'm' e for a Permit to Construct or Repair an Ind' idual Sewage Disposal S!7.st ,.Wt . .. ............ ...................... ........... .......... ............... ............................ ...................... Yst Applic ation tion is he r ocation Addres r Lot ............................... .................................................................................................. ner ........ --- ---- -- .. ... _:� ....................... ....................................... ............ ........................... ------------------ ................. oofe--`7..... Installer Address U Type uilding Size Lot. ---Sq. feet Dwelling—No. of Bedrooms.--_. 1_�----------------Expansion Attic Ab GaWage Grinder -1 A-, Other—Type of Building ---------------------------- No. of persons..__._........---.----_---__ Showers Cafeteria PL4Other fixtures ..... ----------------------------------------------------------------------------------------------------------------------------------------------- Design Flow.............................- gallons per pet-son per day. Total daily flow----------------------------------- ---gallonWs. Septic Tank—Liquid capaci �� allons Length................ Width..--__._-.._-_-- Diameter____...___.---_ Depth---------------- Disposal Trench—No..................... Width --- Total Length--__--____--____-__- Total leaching area------------_------sq. ft. ytilet ..... Total leaching area_----------------S(1. f t. Seepage Pit No--------------------- Diameter ... Depth below Other Distribution box Dosing tank 40 d/— 7 Percolation Test Results Performed by---------------------------------------------------------- --- Date....----------.._-------------------- a Test Pit No. I................minutes per inch Depth of Test Pit-.._____-___--_--_-- Depth to ground water....-__---_.--.._-.-___. �14 Test Pit No. 2................minutes per inch Depth of Test Pit......._......_..... Depth to ground water_.._....._......_..__... .......... ------------ ------- 07 -------;-;--------1. .. 0 V�. a- . . ......D Sfj ------------------------------ 0 o ---------------------------- -------- ------- --------- U --- ----- ----------------- ------ � ----------------- ........ U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual wage Disposal System in accordance with ispo furth agrees not to pl tem in the provisions of Article XI of the State Sanitary Code—The undersi -d cr e s operation until a Certificate of Compliance has bee *s d by ��oa of heal Sig .......... --- ---------------- ------------------------ -- ---------- ------------ le sy Corn to pl- ---------- -------- ---PD... . ...;- 0 Application Approved By_ ..... ... ------------------------- - - 2'"s,72 Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ............................................................................................................................................................................--------------------------- _7_ Date PermitNo--------------------------------------------------------- Issued... ....7................... Date ------------------------------------------------------------- - No......./ F�s.....f`s O o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .jlT.r/'lrC.........._._--OF.........a.�.. ........ /.. r : Appliration -for Ubpagttl Morkii Towi#rurtiott Vrruid Application is.hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 4 ..... f °, ` ' - ------•- --- '---------- -------- -------- ------ -----•---. .•... Location-A,dddrress,�j 1 or Lot N . owner A - -- -- - ----------- Installer Address Type of/Building Size Lot_j ... i"r - -Sq. feet Dwelling—No. of Bedrooms..-__ __-__._ -7_.�=----------------_----Expansion Attic fi1/j Garage Grinder .mp a4 Other—Type of Building ---------------------------- No. of persons_.--_-_-----_-_-__--.--_-- Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow-------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacit . gallons Length---------------- Width................ Diameter------.--------- Depth---------------- x € Disposal Trench—No..................... Width---------.:.,_- ----- Total Length---,--_-_-_-._.---._ Total leaching area....................sq. ft. p,g -_--_- Diameter - _'t___ Depth below inlet __... g area......._.... ....sq. ft. See a e Pit No_______________ Total leachin Z f Other Distribution box ( ) Dosing tank ( ) .: / �"` /* #�w 7e Percolation Test Results Performed by----------------- -------------------------------------------------------- Date----------------------------------- .... Test Pit No. I................minutes per inch Depth of Test Pit_----------_------ Depth to ground water_--------------------- r-T4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth'to ground WW w a ter--.-.----__---_-_--..__ ------------------------ ------- / .____.___.. ----------------------.. 1-." ..... ---•----------------- -tri� og j t S . -- '- � ----------••--- -- j--------------- --------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.-.-_-----.-.._-:_' .__'.:••___________________________________________________________________. -------- ------- --- -- --------- -- - Agreement r The undersigned agrees to -install the 'afore'described Individual"`Sewage roDisposal System in-accordance with the provisions'of Article XI-of the State Sanitary Code— The undersig4d further agrees not to pl tie Vern in operation until a Certificate of Compliance has been ed by th oard of heal /f s I t ---- ---------------- s Date Application ApprovedBY - � J ------ ---------- •. . y'* /�e f Date Application Disapproved f or.'.th'e f ollowing'reasons: -•---- ----- ----- ------- ------------- ------ _:•'�.: r.,d Date Permit No.. ------ Issued. ................... Date hNY ",�,.� 'Yi7 ..i:,t���N4.r+.of r• . r TF6E COMMONWEALTH OF..MASSACHUSETTS t� "`t� BOARD" O ,HEALTH ..... ". .........OF........... � .......................:.........:............. wrrtilirtttr of 'Tomplittttrr TH T E Y, That the Individ&l.Sewage Disposal System constructed <or Repaired ( ) w by _..... ------ ....................................•---••-----•-••-----•••---- 1 J/ j'�► nstiller ... ...... ................. .. ---•------- •-•--- f' ?��e ------- ----- --------.----------•----------.----•-•_----------- ajed n accordance with the provisions I of The State Sanitary Code as described in the ? 4 apphcafi"on for-.•;D,tsposal,W:orks Construction Permit No..._ . .___. --- ---------- date ? ":-_ !..aE.+�_"" ......... �1-HE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEW adILL FUNCTION SATISFACTORY. DATE... ....................... •---•-. --------------- . •-•- ---- ----.... Inspector •-- ---•--------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT G „ r No..- FEE • •-................ i>� tt1 ktr iottrrut `` Permissio hereby granted------ •-• ...... ----------------------- to Cop.st f� pair-�' z)''�n'Indivfid/ a ew9g -sal Syste , � -at N�o � l - -------- ---- -►--------- ----- -------- >------ ---- stye as shown on the application for Disposal Works Construction er o..... .... . ...... ated:. " '° -�i--- oard o ealth 9 B II - DATE.. fi =` � / ter-•, FORM 1255 HOBBS & WARREN. INC.; PUBLISHERS. ,,.-. �t 113 11 8 /v E l.ceA4H 1 PIT' . � Z V �GflT+G PhNK { 33 _ 1=ovNOAT�on� i V { tot ISo A aP �tmT:: 5ELue(ZA6- t t3i.XT R !Ocx:> CTA t SF_'p-!G TA N i - 1 DDO 6-AL RF T sum Lu I'i A I OO "f o l:-MCP C.6QTIFIED PLcsT LOCATION (f, ! L L.� 1 C6RTll=Y T14AT' TNt= V--OUNDATlOtA5"ovj ..► Pl-ate RF--FcVEi-jC-c 4aElZEc�ia Gc�NtPl..�(S W tTN TNT StD'E L1►--16 L©T" � I5 A►.ia SETP�ACIG WC-QUl&Zl=AA;7-&JTs OP TNe `To w U OF " BQXTEIZ IaG. REGlS ru-2Sz— tA(.lp 6UF-v6-,folzS TI-IlS DLA64 l'S Wo—r BASeo 0"1 A'" OSTEfL.VU-IM a I�CASS• If-45riZvAAEtJ T Sv2VE-{ j Ti4a e,140Wlxw APPLI CA "-T- �lc�f 6a USEIJ To DE:Tazmo-lC LOT L I W=5 /�n 1LAN A4.-t.., "X DATE: 7/26/95 PROPERTY ADDRESS:---�0 Prince_ I inckly .. Road_ Centerville i�� __ . ..Centerville ---_ Mass . 02�r-32..:- ------ - On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank. 2 . 1- distribution box. 3. 2-1000 gallon leaching pits . Based on my Insertion, I certify the following conditions: - s 1 . This is a title five septic system. ( 78 Code 2 . The septic system is in proper working order at JUL the present time . 8 199 3 . Sch . 40 4" pipe . anise r w SIGNATURE: -� Name: J. P•.Macd b ' r Jr . i Company:_J. P Macomber. & Spn.' In, . . Address: Box 6.6 , Cent Orvill'e Phone:---SIl$-ZZ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY 1 s JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.A. Box 56 Centerville, MA 02632-0066 773-3338 775-6412 7 "..CD 6 DISPOSAL SYSTEM 12IE��^':. _ Address Of PropettS 50 Prince Hinckley Road CentervilleMass . Owner ' s nurse Michael Pusateri Date of I'Ispection 7/26/95 PART A CHECK LTST Check if the following. have been done: r/ Pumping information was requested of the owner, occupant, and Board of Health. _-LI-4one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the s stem recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ZThe facility or dwelling was inspected for signs of sewage back—up. I/ The site was inspected for signs of breakout.. ,ZAll system components, excluding the SAS , have been located on the site. The septic tank manholes were uncovered opened, and the interior p , error of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _4Z The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. -4-/The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance '.of SSDS." Recommendations 1 . Speed leveler must be installed in the distribution box. This will establish equal flow to leaching pits . 2 . Raise covers on the leaching pits . Covers are to be within : 6" of final grade . 3 . No other repairs are needed . y SUBS.. T-�,CE SEWAGE DISPOSAL SYSTEM I)'�'NPECT.ION PART B SYSTEM INFORMATION FLOW CONDITIONS. If residential 3 number of bedrooms 0 number of current residents Yes garbage grinder, yes or no Yes laundry connected to system, yes or no rjn seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: 1993=151 , 000 gallons=GPD=413 . 69 1994=216 , 000=GPD=591 . 78 Vacant . Last date of occupancy Unknown GENERAL INFORMATION Pumping records and source of information: No System pumped- as part of inspection yes or no if yes, volume pumped Reason for pumping: Type of system XXXX Septic tank/distribution box/soil absorption system NO Single cesspool NO Overflow cesspool NO Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of. all components. Date installed, if known. Source of information: 15 years , O Sewage odors detected when arriving at the site, yes or no 1 J 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK:}e�� uMon tank . , (locate on site p an depth below grade : 141" material of construction: XXXXconcrete metal FRP other(explain) dimensions: L_Qt 6,1 H=5 ' 7" W=4 ' 1011 NnnPsludge depth _n distance from top of sludge to bottom of outlet tee or baffle _p_ scum thickness _q_ distance from top of scum to top of outlet tee or baffle ,.._p distance from bottom of scum to bottom of .outlet tee or baffle Tank pumped 3 weeks ago Comments : (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) eb � be umnarl onna a gear . RPacnn - Cgrhaop di snosal nr e_sent _ Tnlet R Hilt let tees fine _ and baffle on inlet . Water level at not 1Pt invPr't i - 41311 _ Tank structurally sound : No signs of leakage . No recommendations for repairs . DISTRIBUTION BOX: XXXX (locate on site plan) NO depth of liquid level above outlet invert Comments: (note .if level and distribution is equal, evidence of solids carryover, evidenc•s of leakage into or out of box, recommendation -for repairs, etc.) Distribution box not level and distribution of watPr ie nnt- "rliaj No solids carry over or leaka2e in or nut of the_ distrihut_ion hoy eed leveler must be installed in the distribution hnx to P.etahli equal flow to both leachihR Tits . PUMP CHAMBER: NONE (locate on. site plan) NONE pumps in working order, . yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) NONE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION rORX PART B SYSTEM INFORMATION coatinued SOIL ABSORPTION SYSTEM (SAS) : YES f (locate on site plan, if possible; excavation not required, but `may -be - approximated by non-intrusive- methods) If not determined to be present, explain: Type leaching pits and number _9_6117 leaching pits leaching chambers and number NnMF, leaching galleries and number NONF leaching trenches, number, length NnNF leaching fields, number, dimensions N1nNF overflow cesspool , number NnNF Comments: (note condition of soil , signs of hydraulic failure, level of ponding., conditionGravel el vegetation,o hydraulic failure failurdetoronponffnra�etenan�enor repairs,etc. g norm COMPrS on nits must . be raise e ow . CESSPOOLS (locate on site plan) : number and configuration NONE depth-top of liguid to inlet invert -J depth of solids layer NONE depth of scum layer dimensions of cesspool materials of construction NUNE indication of groundwater inflow (cesspool must be pumped as part of inspection) NONE ------------- Comments: (note condition of soil, signs of hydraulic failure, level 'of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) , DI n-yX ----------------- PRIVY: (locate on site plan) materials of construction NONE dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, - level Of.ponding, condition of vegetation, recomme dations for maintenance or repairs,r NON . it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .POR.M PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Town Water 0 DEPTH TO GROUNDWATER 20 '+ depth to groundwater method 'of determination or approximation: _Test hole for installation o Water . � s,—a f Ri!0f Qf i i 1 nff ground water 12 SUBSURFACE .SEWAGE DISPOSAL SYSTEM 'INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? Discharge or ponding of effluent to the surface. of the ground or surface waters? u� Static liquid level in the distribution box above outlet invert? �r rs . Liquid depth in ..e1 <6" below invert or available volume< 1/2 day flow? _ Required pumping 4 'times or more in the last year? number of times pumped IVQ_ Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? _4 within 50 feet of a surface water? _V0 within 100 feet of a surface water supply or tributary to a surface water supply? within a zone I of -a public well? within 50 feet of a bordering vegetated wetland or salt marsh- (cesspools and .privies only, not the SAS) ? `(Z within 50 feet of a private water supply well? C) less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of' well water anal, �. .for coliform bacteria, volatile organic compounds, ammonia nit rogeni and nitrate nitrogen. TOWN OF Barnstable BOARD OF HEALTH i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION �r.:rcc�e:__r=-:ram•a:•xrc-=.s-+:s_�r-ate.asp.:=:r_�:���zz�.arx-s=-���::.v=:-.r.�—cs_z--sr.�srrs:ar_.s:a+ns—rscrs::.:rsss-.-s:c-i-r.•r.d —TYPE OR PRINT CI.EARLY— PROPERTY INSPECTED STREET ADDRUS 5r' Prince Hinc.kly Road Centerville ,Mass . 02632 ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Michael -Pusateri PART D - CERTIFICATION NAME OF INSPECTOR J.P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Ce.nterville,Mass . 02632-0066 Street Town or City State ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : XJX2L System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 7/28/95 .asp One copy of this c� tification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTIi. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the a.nspectio;i , .:nless allowed or required otherwise as provided in 310 CMR partd.doc Cc,„monwecm, cr MassCC:7::SeM ExecuTwe Criice cr Envircr.menTC Department of Environmental Protection Water Pollution Control Tecnncel Asswcnce and Training Secnons MUI&m F.Weid Goy.mar Trudy Coz• Soavwy.EOEA Thom&,& Powwa 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and Son PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , I am pleased to inform you that you have attended training, met the experience qualifications, and have passed the Title 5 System Inspector exam, pursuant to 310 CMR. 15 . 340 . The passing grade for the exam was 39/52 or 75%. This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15. 340 . You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D.E. P. Training Center SO Route 20 Millbury, MA 01527 Thank you very much for }.oar time and consideration in this matter. Sincerely, Kimball DEP Traininq Ce';;cer Director (2405) Route 20 9 s.idbury, MA 01'..'; • FAX SCa-755-9253 • 1'n,., •,n• 509-756-7"l' Water , Conservation SAVE Tips ME! , . CHECK FOR LEAKS : Water Loss in Gallons Due to Leaks Leak this Loss Per Day . Loss Per Month Size 120 3,600 360 10,800 • 693 20,790 • 1,200 36,000 1,920 57,600 3,096- 92,880 0 4,296 128.980 ® 6,640 199,200. 6,9.84 200,520 8,424 252,720 9,888 296,640 11,324 339,720 12,720 381,600 ® 14,952 448,560